Attention Providers of Sections 13, 21 and 29: Periodic Re-evaluation of Plan of Care Requirement 

Jun 09, 2022

This is a reminder that Targeted Case Managers supporting adults with Intellectual/Developmental Disabilities and/or Autism who are classified on MaineCare Benefits Manual Section 21 or 29 waivers must meet the following standards:  

• Re-evaluation of the Individual Plan of Care must occur when a change in the member’s needs occurs, or at a minimum every 90 days (Section 13.02.B.1). 

• The member’s Personal Plan must be reviewed, revised, and updated at least annually, based on the plan’s effective date or at the request of the member or guardian (Section 21.04-4). 

When a 90-day review falls within 14 calendar days prior to the date of the annual plan, the Department will excuse providers from performing that 90-day review as long as the annual review is completed by the annual plan review date. The provider must complete the annual review by its due date in order for services delivered during the 14-day period to be billable. If the annual review is not completed by its review date, the provider may not bill for services provided within that 14-day time period and must reverse any claims already submitted to MaineCare.  

When a 90-day review is due more than 14 calendar days before the date of the annual plan, the provider must complete the 90-day review and a separate annual plan in order to bill MaineCare for services. 

Please contact your Provider Relations Specialist with questions.